a client has a nursing diagnosis of altered sleep patterns related to nocturiwhich client instruction is important for the nurse to provide a client has a nursing diagnosis of altered sleep patterns related to nocturiwhich client instruction is important for the nurse to provide
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Nursing Elites

HESI RN

HESI Fundamentals Practice Test

1. A client has a nursing diagnosis of Altered sleep patterns related to nocturia. Which client instruction is important for the nurse to provide?

Correct answer: A

Rationale: The correct instruction for the nurse to provide is to advise the client to decrease intake of fluids after the evening meal. By reducing fluid intake before bedtime, the client can minimize the need to void during the night, which can help improve sleep patterns affected by nocturia. Choices B, C, and D are incorrect. Drinking cranberry juice or warm decaffeinated beverage at bedtime may increase fluid intake, exacerbating the nocturia issue. Consulting the healthcare provider about a sleeping pill should not be the first intervention, as it is important to try non-pharmacological approaches first.

2. When developing a plan of care for a male client admitted with delirium tremens, who is dehydrated, experiencing auditory hallucinations, has a bruised, swollen tongue, and is confused, what action should the RN include to ensure the client is physiologically stable?

Correct answer: B

Rationale: Monitoring vital signs is the priority action to ensure the physiological stability of a client with delirium tremens. In this scenario, the client's dehydration, confusion, and other symptoms necessitate close monitoring of vital signs to assess their condition accurately. Encouraging oral fluids (Choice A) is important for hydration but does not directly assess physiological stability. Keeping the room dark (Choice C) may help with hallucinations but is not the primary intervention for physiological stability. Applying ice to the tongue (Choice D) addresses a symptom but is less critical compared to monitoring vital signs in this situation.

3. What does reproductive health refer to?

Correct answer: C

Rationale: Reproductive health refers to the overall well-being of the reproductive system, including both the organs and their functions. It encompasses the ability to have a satisfying and safe sex life, the capability to reproduce, and the absence of reproductive problems. Choice A is incorrect because reproductive health is not solely about having a healthy baby but also includes the health of the individual. Choice B is incorrect as it focuses only on sexual activity frequency rather than the holistic well-being of the reproductive system. Choice D is incorrect because a longer lifetime does not specifically relate to reproductive health.

4. Which of the following is often referred to as the powerhouse of the cell?

Correct answer: C

Rationale: Mitochondria are known as the powerhouse of the cell because they generate most of the cell's supply of ATP, which is the energy currency used for various cellular processes. The nucleus (Choice A) is the control center of the cell, housing genetic material. Chromatin (Choice B) is a complex of DNA and proteins within the nucleus. Ribosomes (Choice D) are responsible for protein synthesis and not the primary energy production in the cell.

5. A client scheduled for a bronchoscopy in the morning is anxious and asking the nurse numerous questions about the procedure. Which intervention has the highest priority in preparing the client for the procedure?

Correct answer: C

Rationale: Encouraging the client to write down questions is the highest priority as it allows the nurse to address concerns systematically, reducing anxiety. This approach empowers the client and ensures that all concerns are covered before the procedure, reducing the risk of miscommunication or unaddressed fears. Providing detailed education about the procedure (choice A) is important but may not address the client's immediate anxiety. Administering anti-anxiety medication (choice B) should only be done if other interventions are ineffective or if prescribed by the healthcare provider. Reassuring the client about the safety of the procedure (choice D) is essential but may not address the specific questions and concerns causing anxiety.

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